Journal paper analysis of SCFE fixation

3. Introduction
• Controversy remains whether the
contralateral hip should be fixed or not.
• Proposed indicators – age, gender, weight,
bone age, endocrine disorder, symptomatic
contralateral hip.
• Posterior slope angle of physis of >12 deg of
C/L on axial radiograph.

4. PSA

5. Universal C/L Fixation
For
• 30-40% incidence- severe
and unpredictable.
Against
• Majority does not slip.
• Risk of chondrolysis,
subtrochanteric fractures
and prolonged surgical
time.
• 70% have mild slip; can
have FAI and early arthritis
later.

6. Aim
• Comparison between the two groups for –
– Complication rate
– Functional status
– Radiographic evidence of CAM lesions and OA
changes.
• Cost analysis of prophylactic fixation of C/L
hip.

7. Materials and Methods
• 91 pts between Jan 2000 and Dec 2010 with
U/L or B/L SCFE.
• 86 recruited.
• Excluded- 4 b/l slips with endocrine
abnormalities and one outside catchment
area.
• Patient residing within the catchment area,
who were treated at hospital. Also included
pts who received intial management outside.

8. • M:F= 54:32
• Mean age of 12.3 years
• Procedures and decision for C/L hip fixation
decided by consultant.
• Single fully/ partially threaded cancellous
screw with atleast three threads across the
physis.
• Lateral femoral entry point was proximal to LT
and joint penetration avoided.

9. Data
• Operation register and medical records.
• Information obtained-
– endocrine dysfunction,
– whether they had unilateral or bilateral fixation; if
this was prophylactic or not,
– whether a subsequent slip occurred on the
contralateral side

10. Complications
• infection
• screw removal
• periprosthetic fracture
• chondrolysis
• avascular necrosis (AVN)
• conversion to THR

11. • SES estimated by Scottish index of multiple
deprivation.
– Employment
– income and benefits
– Recorded crime rates
– Housing
– health and healthcare use
– education
– access to services and transport

12. • Telephonic interview
• SF-12 and OHS( Oxford Hip Score)
• Radiographs(post 2007; PACS), analysed for
PSA of the physeal slope on AP and frog leg
views.
• Most recent x rays assesed for presence of
cam lesion and kellgren lawrence grading
done for OA.

13. • Quality adjusted life year (QALY) calculated
using difference between health gain between
those who underwent fixation and those who
did not.
• SPSS, Student t test, Mann whitney U test, Chi
square analysis.

14. Results

15. • No significant difference in age, gender,
associated endocrine abnormality or
socioeconomic status.
• 23/50 patients(46%) whi underwent U/L
fixation suffered a later slip.(128 d)

16. C/L SCFE
• 2 patients with implant exit and planned for
scopy.
• 1 patient- Severe slip; Southwick osteotomy.
Planned for THR at 23 yrs age.
• No deep wound infections, chondrolysis or
periprosthetic infection of the C/L hip.

18. X rays
• Initial x rays showed a significant difference
between patients with U/L fixation who didn’t
have a later slip and those who did.

19. Latest radiographs
• 28 (56%) radiographs available for the
unilateral group and 31 (86%) available for the
prophylactic group.
• In total eight cam lesions were observed, all in
the group that did not undergo prophylactic
fixation.
• Three of the cam lesions were observed in
patients that went on to have a symptomatic
slip on the contralateral side

20. • Two patients with symptomatic FAI and grade
1 changes of OA.
• Five patients who had unilateral fixation only,
with no symptomatic further slip on the
contralateral side, had cam lesions which were
not present at the initial presentation.

21. Economic Cost

22. Conclusion
• Patients undergoing prophylactic fixation at
the study centre had-
– lower rate of complications
– better functional outcome
– lower rate of radiographic cam lesions
• compared with those who underwent
unilateral fixation.

23. • Cost-effective procedure with a cost per QALY
of £1431

24. Limitation
• Retrospective study
• Assumption that all patients had an equal SF-
12-6D score at eight years despite a wide
range of follow-up.
• Patients were not randomised to each group,
with the choice to perform prophylactic
fixation being at the consultant’s discretion.

25. • Results may help parents make an informed
decision when offered prophylactic fixation.
• Study does not offer a definitive answer
whether prophylactic fixation should be
performed in all patients.
• A prospective multicentre randomised
controlled trial is required.